The day started with a demonstration of the CSW system by Dave Nurse which
uses XML to integrate clinical textbooks with the EPR. No solution had yet been
found to issues around a financial model for use of 3rd party publishers
material - except on a subscription basis.

Next was a short piece by Muir Gray setting the context related to the DGH
& patient information use, this gave pointers to 21st century practice.
This was followed by a short talk about the National research register.

The Users Views Chaired by Professor
John Williams, School of Postgraduate Studeis in medical and Health care,
University of Swansea,

The Clinical Team - Mr Lawrence Roberts,
Scunthorpe & Goole NHS Trust

Lawrence described and demonstrated the development on an intranet for the
Obstetrics and Gynaecology unit at Scunthorpe hospital. He highlighted the need
for relevance to users, speed of access, coherence of material and the ability
to give feedback. In particular local guidelines and protocols had been
made available - although these were not available to the public. There were
particular issues about access (number of PCs) information archiving and the
training gap amongst staff.

Pam discussed how this service in Cornwall acted as an information provider
to staff on disparate hospital sites and had started to offer a range of
services over their managed network. Both advantages and disadvantages and
training and technological issues were highlighted , with the need for further
research, particluarly to show effects on clinicans behaviour in the use of
evidence, and ultimately into the effects of improved information on patient
care.

Jonathon described the system they have used to provide support to
practitioners at the point of care by providing context sensitive guidelines in
relation to path lab results, over the Oxford Clinical Intranet. This had been
studied to examine it's use by clinical staff over 2 years. The full report is
available on the web. Conclusions included 15 seconds being much too long for
access and the need for thin client wireless network hand held computers. He
divided information into Immediate needs (ie needed within a few seconds for
clinical decisions) and Thoughful needs (which involve education, reflection
and professional development where a longer timescale is acceptable/desirable).

Jeremy summarised a range of studies trying to identify what information
clinicans actually need, as opposed to might want, and what is essential for
patient care. He argued that we are in a catch 22 siutuation where you can't
p[roperly study infortmation use until a comprehensive knowledge resource is
available and yoiu can't create this until yoiu know what users needs are.
jeremy will be providing the evaluation of the NeLH.

Making it all work - Dr Simon Weston-Smith, Hastings & Rother NHS
Trust.

Simon described the intranet devloped in the trust and moves towards the
EPR, and set out what would be needed from an electronic library to support
this - however they had not as far as providing many of the services he saw as
being useful.

Sarah introduced and demonstrated the start here simple button system for
touchscreen access to health information - an attempt (by a charity) to provide
a universal portal, partyicularly for the disable and others with a health
information need.

Muir outlined his view of the NeLH using a variety of analogies. He
described the Atrium and 4 "floors". The atrium will contain
knowledge cafes for single professional groups (during the lunch break further
work was done on planning the nursing area) and virtual branch libraries.

The network and it's pathways - Ben Toth NHSE Bristol

ben described various possible models for making NeLH available, these
included local intranets or VPNs (Virtual Private Networks) and via NHSnet or
the Internet itself.

Tony analysed payment for health information, in the light of his
international experience, and highlighted links to a nations GDP and set out
guide for which information should be paid for by government and when by the
individual.

The Debate - Chaired by Muir
Gray

BMJ - Tony Delamothe
Discussed publishing paradigms & providers/knowledge support systems e.g.
OVID. He concluded that information provision must be by open protocols &
essentially this means the Web.

British Library - Bruce Madge
Presented ideas and developments under the headings of:

connectivity

connectivity

competence

He raised issues about the integration of information from various sources and
considered the use of classification systems such as UMLS.

Informatics
Specialists - Colin Gordon
Set out the purpose and workings of the forthcoming NeLHealth Informatics.

Clinicians - Andrew Roberts
Described developments in clinical audit to encourage all clinicians to use
information systems which make knowledge sources inescapable in practice.

Comments from the audience were welcomed particularly in relation to the
special needs of hospital based health care (as opposed to primary care) -
various issues were raised around trust organisation e.g. information
directorates, access issues and education and training - The overall comment
was a need for culture/behaiour change.

There are lots of good ideas about what the NeLH can and can't achieve, but
still some very major barriers to be overcome. Technical issues about the
production of the NeLH appear to be less than those at local level which enable
users to get access. Human/organisational/cultural issues are still the greater
hurdle and the importance of education and training was highlighted.

The intention is top write up the proceedings of the day & place them on
the web - A link will be placed here.